Modified super-long down-regulation protocol improves fertilization and pregnancy in patients with poor ovarian responses

Background The successful end-point of in vitro fertilization （IVF） treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a ＂poor response＂. How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF. Methods The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle （group A） received routine long protocol; the subsequent cycle （group B） received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student＇s t test and Z2 test where appropriate. Results The patients＇ average age was （36.64±3.85） years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone （FSH） was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin （hCG） day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B. Conclusions This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.

Revised Super-long Down-regulation Protocol Improves the Outcome of Infertile Patients with Repeated Implantation Failure in IVF/ICSI-ET

Objective To investigate the outcome of revised super-long down-regulation protocol （RSDP） for in vitro fertilization / intracytoplasmic sperm injection-embryo transfer （1VF/1CS1-ET） in the special infertile patients with repeated implantation failure （RIF）. Methods Patients with RIF were divided into RSDP group and routine long downregulation protocol （RLDP） group. In RSDP group, gonadotropin releasing hormone agonist （GnRHa） was injected intramuscularly by 2.5 mg in mid-luteal phase for the ftrst time and 1.25 mg after 28 d; gonadotropin （Gn） was started 14 d later after the second GnRHa dose. IVF/ICSI-ET was performed according to the routine procedure. The clinical outcomes of RSDP group were compared with those of RLDP group. Results In RSDP group, the number of retrieved oocytes and valid embryos was significantly lower （P〈0.05）; there were no significant differences about fertilization rate （P〉0. 05）; both good-quality embryo rate and implantation rate were significantly increased （P〈0. 005）; clinical pregnancy rate was obviously improved （P〈0. 05）, as compared with RLDP group.Conclusion RSDP can improve the IVF outcomes significantly in RIF patients.

A Modified Ultra-Long Downregulation Protocol Improves Pregnancy Outcomes in High Body Mass Index Patients Undergoing In vitro Fertilization/Intracytoplasmic Sperm Injection Treatment

Objective:Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome.The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index(BMI)undergoingin vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI),compared to the long protocol(LP).Methods:We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching(PSM).Patients were divided into two groups:modified ultra-LP(MULP)(n=1,960)and LP(n=1,960).Results:In the MULP group,live birth rate(52.65%vs.46.79%,P<0.001,odds ratio[OR]:1.784,95%confidence interval[CI]:1.563-2.036),clinical pregnancy rate(62.50%vs.57.91%,P=0.003,OR:1.211,95%CI:1.066-1.377),and implantation rate(53.24%vs.49.65%,P=0.004,OR:1.155,95%CI:1.048-1.272)were statistically significantly higher than those of the LP group.Moreover,the cycle cancellation rates(12.70%vs.15.15%,P=0.027,OR:0.815,95%CI:0.68-0.977),abortion rates(12%vs.14.8%,P=0.046,OR:0.785,95%CI:0.619-0.996),and ectopic pregnancy rates(1.06%vs.2.11%,P=0.04,OR:0.497,95%CI:0.252-0.98)were lower than those in the LP group.Conclusion:The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment,providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.

Effect of Long Protocol on the Outcome of In Vitro Fertilization-embryo Transfer in Patients with Endometriosis Compared with Prolonged Protocol

Objective To investigate the effect of different down-regulation protocol on the in vitro fertilization-embryo transfer （IVF-ET） outcomes in infertile patients with endometriosis （EMs）.Methods A retrospective case control study was performed. Totally 294 infertile patients with EMs were enrolled. And 109 patients （116 cycles） received prolongedprotocol as the control, 185 patients （193 cycles） received long protocol as case group, all followed by standard controlled ovarian hyperstimulation （COH）. Response to gonadotropins, the fertilization rate, the cleavage rate, the implantation rate, the clinical pregnancy rate and the miscarriage rate were measured and analyzed between the two groups. Results A trend toward better ovarian response was observed in long protocol group. Higher fertilization rate, lower total dose of rFSH, shorter duration of stimulation and more endometrial thickness on the day of hCG injection were observed in long protocol group compared with those of prolonged protocol group, and the difference was significant （P〈0.05）. In addition, the clinical pregnancy rate, the cleavage rate and the implantation rate also had an increase trend in long protocol group compared with those of prolonged protocol group, but without significant differences. Conclusion Long protocol regimen before IVF-ET in patients with EMs resulted in a trend toward better ovarian response and higher clinical pregnancy rates than prolonged protocol regimen did.